66 vials of antivenin later, boy bitten by rattler is OK

From left to right, pediatric residents Ralph Martello and Christian Kegg, along with RN Stephanie Clifford, check on Newberry resident Ben Smith, 11, who has been hospitalized since being bitten by an eastern diamondback rattlesnake.

Published: Sunday, June 9, 2013 at 6:01 a.m.

Last Modified: Saturday, June 8, 2013 at 6:12 p.m.

Benjamin Smith's parents kept vigil by their 11-year-old son's bedside at UF Health Shands Hospital last week as doctors administered at least 66 vials of antivenin as of Friday — more than twice the amount considered as the top range for a life-threatening snakebite.

Facts

Do's and don'ts related to snakes

To prevent snakebites:

If you see a snake, back away from it slowly and don't touch it.

If you've been bitten by a snake:

Do's:

Keep still and calm because that slows the spread of venom.

Call 911 or EMS immediately.

Cover the bite with a clean, dry dressing, and position it below the heart if possible.

Take a picture of the snake, or remember its color and size.

Don'ts:

Pick up a snake or try to trap it.

Apply a tourniquet or ice to the wound, or try to suck out the venom.

Walk in high waters such as floodwaters, or go tubing in those waters.

Source: Alachua County Health Department

As the weekend arrived, Benjamin was much better. “He's ready to go home,” said his mother, Heather Smith.

Just a week before, Benjamin was running through a wooded area in Newberry at a friend's birthday party when he felt a sharp pain, like a knife had cut his leg.

Then he looked down and saw a snake — a diamondback rattlesnake — one of the most venomous snakes in the country.

Benjamin ran before the snake could strike again, and his friends and older sister scooped up the 65-pound boy and carried him to safety. “The area where it hurt was hot and was spreading,” Benjamin said Friday from his bed at the pediatrics ICU at Shands.

A week after the bite, and 66 vials of antivenin treatment later, Benjamin sat restlessly in his bed, surrounded by a dozen or so “get well” balloons, cards from friends and classmates at Oakview Middle School, and his favorite drink, Yoo-hoo, which one of his teachers had brought him.

Snakebites are not uncommon in Florida: the night Benjamin was bitten, there was another boy bitten by a snake in the ER, and on Saturday a Shands spokesperson said the hospital had treated three individuals for snakebites in the past week. While bites from cottonmouths and pygmy rattlesnakes are more common, those from a diamondback rattler are relatively rare.

Benjamin's doctors said that when he came in, they gave him a medication for coagulopathy, a common condition following snakebites that impairs the ability of the blood to clot. That's why, if left untreated, you could bleed to death from a snakebite, said Dr. Christian Kegg, a pediatric resident at Shands and one of the doctors who cared for Benjamin.

They also started pumping antivenin into his body, which Shands keeps in store as a Level 1 trauma center. The drugs work by binding to the venom and destroying it; and then the body naturally eliminates it, Kegg said.

Children bitten by small rattlesnakes are usually treated with 10-12 vials, said Dr. Ralph Martello, also a pediatric resident who treated Benjamin. By Friday, 66 had been used on Benjamin — which Kegg believes is a record for the hospital. One vial costs thousands of dollars, Kegg said. Doctors said they expect to give Benjamin more antivenin this weekend.

“The Eastern diamondback is one of the worst to treat because patients have multiple relapses,” Kegg said.

Doctors say the large number of vials required for Benjamin are because the snake was a diamondback and because Benjamin was bitten on his right quad muscle, which worsened the effects of the bite.

Benjamin relapsed several times over the week, requiring more and more antivenin. Doctors said only one of the rattler's two fangs actually penetrated Benjamin's skin, apparently because the other fang likely hit a button on the cargo pants that Benjamin was wearing.

Martello added that Benjamin's condition was up and down. The shelf life of the antivenin is just 12 hours, but a snake's venom can stay in the body for a week. The only clinical way to gauge whether the venom has passed through the body is to measure the clotting capacity in the blood.

Friday, for the first time in a week, Benjamin ventured outside Shands in a wheelchair, and he'll probably walk on crutches for a while after he gets home.

He made drawings during art therapy at Shands, and for a while the body of the 5-foot-long rattler that bit him — which the birthday boy and his father went back and killed — was placed in a cage outside his hospital door for “show and tell,” his mother said.

“He thinks he wants to make a wallet (from the skin),” she said.

Kegg said Benjamin was lucky to have access to the antivenin right away. It has to be used within 12 hours of the bite, he added.

The doctors recommend that people always get checked out by a doctor after being bitten by a snake — even those with “dry bites,” in which no venom is released. Especially with hurricane season starting, snakes are often displaced to higher ground, and that's often when people are bitten, said Paul Myers, administrator of the Alachua County Health Department.

Kegg said people need to be especially wary of the cottonmouth. “They're less venomous than the diamondback, but a lot quicker to strike.”

<p>Benjamin Smith's parents kept vigil by their 11-year-old son's bedside at UF Health Shands Hospital last week as doctors administered at least 66 vials of antivenin as of Friday — more than twice the amount considered as the top range for a life-threatening snakebite.</p><p>As the weekend arrived, Benjamin was much better. “He's ready to go home,” said his mother, Heather Smith.</p><p>Just a week before, Benjamin was running through a wooded area in Newberry at a friend's birthday party when he felt a sharp pain, like a knife had cut his leg.</p><p>“My first thought was, 'Someone got me really hard (with the paintball gun),” said Benjamin.</p><p>Then he looked down and saw a snake — a diamondback rattlesnake — one of the most venomous snakes in the country.</p><p>Benjamin ran before the snake could strike again, and his friends and older sister scooped up the 65-pound boy and carried him to safety. “The area where it hurt was hot and was spreading,” Benjamin said Friday from his bed at the pediatrics ICU at Shands.</p><p>A week after the bite, and 66 vials of antivenin treatment later, Benjamin sat restlessly in his bed, surrounded by a dozen or so “get well” balloons, cards from friends and classmates at Oakview Middle School, and his favorite drink, Yoo-hoo, which one of his teachers had brought him.</p><p>Snakebites are not uncommon in Florida: the night Benjamin was bitten, there was another boy bitten by a snake in the ER, and on Saturday a Shands spokesperson said the hospital had treated three individuals for snakebites in the past week. While bites from cottonmouths and pygmy rattlesnakes are more common, those from a diamondback rattler are relatively rare.</p><p>Benjamin's doctors said that when he came in, they gave him a medication for coagulopathy, a common condition following snakebites that impairs the ability of the blood to clot. That's why, if left untreated, you could bleed to death from a snakebite, said Dr. Christian Kegg, a pediatric resident at Shands and one of the doctors who cared for Benjamin.</p><p>They also started pumping antivenin into his body, which Shands keeps in store as a Level 1 trauma center. The drugs work by binding to the venom and destroying it; and then the body naturally eliminates it, Kegg said.</p><p>Children bitten by small rattlesnakes are usually treated with 10-12 vials, said Dr. Ralph Martello, also a pediatric resident who treated Benjamin. By Friday, 66 had been used on Benjamin — which Kegg believes is a record for the hospital. One vial costs thousands of dollars, Kegg said. Doctors said they expect to give Benjamin more antivenin this weekend.</p><p>“The Eastern diamondback is one of the worst to treat because patients have multiple relapses,” Kegg said.</p><p>Doctors say the large number of vials required for Benjamin are because the snake was a diamondback and because Benjamin was bitten on his right quad muscle, which worsened the effects of the bite.</p><p>Benjamin relapsed several times over the week, requiring more and more antivenin. Doctors said only one of the rattler's two fangs actually penetrated Benjamin's skin, apparently because the other fang likely hit a button on the cargo pants that Benjamin was wearing.</p><p>Martello added that Benjamin's condition was up and down. The shelf life of the antivenin is just 12 hours, but a snake's venom can stay in the body for a week. The only clinical way to gauge whether the venom has passed through the body is to measure the clotting capacity in the blood.</p><p>“We're continually watching him. He's doing a lot better now,” Martello said.</p><p>Friday, for the first time in a week, Benjamin ventured outside Shands in a wheelchair, and he'll probably walk on crutches for a while after he gets home.</p><p>He made drawings during art therapy at Shands, and for a while the body of the 5-foot-long rattler that bit him — which the birthday boy and his father went back and killed — was placed in a cage outside his hospital door for “show and tell,” his mother said.</p><p>“He thinks he wants to make a wallet (from the skin),” she said.</p><p>Kegg said Benjamin was lucky to have access to the antivenin right away. It has to be used within 12 hours of the bite, he added.</p><p>The doctors recommend that people always get checked out by a doctor after being bitten by a snake — even those with “dry bites,” in which no venom is released. Especially with hurricane season starting, snakes are often displaced to higher ground, and that's often when people are bitten, said Paul Myers, administrator of the Alachua County Health Department.</p><p>Kegg said people need to be especially wary of the cottonmouth. “They're less venomous than the diamondback, but a lot quicker to strike.”</p><p><i>Contact Kristine Crane at 338-3119 or kristine.crane@gvillesun.com.</i></p>